Cloward technique for obtaining iliac crest bone graft in hand surgery

Abstract

The Cloward method for obtaining autogenous iliac crest bone graft requires a smaller incision, less dis­ section, is technically simple, can be performed more rapidly, and has a lower morbidity than conventional open procedures. The graft is a high quality bicortical plug, suitable for use in compression arthrodesis tech­ niques. We have used this technique for obtaining iliac crest bone graft for intercarpal arthrodeses. scaphoid osteotomies and fusions, phalangeal and metacarpal lengthening, grafting of distal radius fractures, and re­ construction of bone tumors of the hand. This method is an excellent alternative to standard open harvesting of iliac crest bone graft and. is well suited for surgery in the hand and wrist. Technique Cloward device is perpendicular to the outer table of the blade of the ilium when obtaining the bone graft. Because of the curvature of the blade of the ilium, the drill will be pointing in a superior direction (Fig. 2). It is for this reason that the incision is made inferior to the iliac crest. The fascia overlying the gluteus medius is incised transversely and the muscle fibers are bluntly split longitudinally exposing a small area of the outer table of the iliac crest. The split in the muscle is no larger than is necessary to admit the dowel cutter. Be­ cause the muscle is bluntly split in the direction of its fibers rather than cut the bleeding is minimal. The Cloward device is positioned perpendicular to the blade of the ilium and the center pin is drilled into the outer table until the teeth of the dowel cutter are seated into the bone. The slider is then released and the dowel cutter drilled through the inner table. With continued rotation of the brace the bone plug is avulsed extra­ periosteally from the iliacus muscles within the pelvis. The ejector is used to remove the bone graft from the dowel cutter. The resulting bicortical plug is shown in Fig. 3. After the bone plug is withdrawn absorbable gelatin sponge (Gelfoam) soaked in thrombin solution is placed within the hole in the iliac crest. The remainder of the surgical procedure on the upper extremity is completed and then the iliac crest incision is closed. The excess hemostatic material is removed before clo­ sure. No drains or bone wax are necessary.